Remote Prior Authorization Rn Jobs in Sugar Land, TX

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Clinical Care Manager (CCM) are RNs who serve as a key member of the UnitedHealthcare Global Emergency Response and Assistance Center Team and utilize evidenced based practice to assess global traveler's medical care needs, treatment plans of healthcare providers and the ability of the local healthcare systems to provide appropriate quality and cost effective care when acute, chronic or catastrophic events occur in countries around the world. CCMs evaluate, recommend and monitor patient status and associated treatment plans to ensure complex medical cases are managed to the highest level of quality and patient safety. CCMs coordinate with appropriate providers and assist in establishing and implementing plans including but not limited to a patient's medical monitoring, return home, and safe evacuation to a location where appropriate care is available when it's determined the care needs cannot be met in the current location.  Services may also include support for travelers into the USA with complex treatment needs, appointment arrangement, receiving facility acceptance, clinical case management, client updates, and discharge planning in support of their return to their home country after care.

CCMs establish a good relationship with the hospital, nurses, doctors, and social workers gaining their trust and respect to facilitate the collection of information and improve the image of the company and patient care. CCMs document all conversations with providers and physicians, medical records review and any patient care related phone call to ensure information is available to all team members for continuity and care management.  The CCM identifies and escalates potentially fraudulent activities identified during the pre-authorization evaluation process.  Complex and high-cost cases are uniquely reported, monitored and supported through the collaboration with all members of the Emergency Response and Assistance Team to include Medical Directors, Global Care Consultants, and Healthcare Intelligence team members to facilitate seamless provision of healthcare services to those we serve. 

*** Candidates must be available to work 8-to-12-hour shifts including every other weekend and holidays as dictated by needs of business in a 24/7 environment ***

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Managing global assistance cases
• Collaborating with interdisciplinary team members (eg: logistical and healthcare intelligence) as appropriate on case work
• Collaborating with Medical Directors and Physician Advisors when appropriate
• Triage global medical cases, complete clinical assessment and communication of case direction to the logistics specialists to facilitate the necessary evacuation or continued monitoring of care being provided locally
• Works collaboratively with international and domestic healthcare providers and internal colleagues to assure appropriate high quality cost-effective care management, proactive discharge and medically safe travel planning, optimize patient health 
• Participates in the management of complex medical cases and collation of clinical information to assess and expedite assessment of care needs. This includes obtaining and reviewing verbal and written medical reports / records as well as communicating directly with the treatment facilities and providers
• Engages in provider and facility quality assurance review as determined by business need 
• Other duties/projects as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Bachelor's degree (BSN) or equivalent experience
• Holds active licensure in the United States as a Registered Nurse
• 3 years of critical acute care clinical experience including but not limited to ER, ICU, critical care, trauma, triage and/or international travel nursing experience
• Proficient in medical terminology
• Proficient with Electronic Medical Records, Microsoft Word and Excel including online computer systems for data entry, research and information gathering 
• Ability to work 8 - 12-hour shifts including every other weekend and holidays as dictated by needs of business in a 24/7 environment 

Preferred Qualifications:

• Experience and/or broad medical knowledge in medical assistance business, experience in aeromedical, flight nursing, cruise line, air medical transport, and/or international travel nursing
• International travel experience with awareness and understanding of the variation in cultures and the challenges of healthcare delivery in the global arena and the potential impact on the health and safety of travelers
• Familiarity with evidence-based practice guidelines 
• Second language proficiency (Spanish, French, Portuguese, Arabic, Mandarin or other)

Soft Skills:

• Problem Solving - Ability to identify and resolve problems quickly, gathers and analyzes information skillfully; develops alternative solutions; works well in group problem solving situations; uses reason when dealing with emotional topics
• Interpersonal skills - Focuses on solving conflict, maintains confidentiality; listens to others without interrupting; keeps emotions under control, remains open to others' ideas and tries new things.  Demonstrates strong customer service; includes managing difficult situations
• Works well in multidisciplinary team environments and is comfortable working independently
• Synthesize complex or diverse information from multiple information sources. Uses intuition and clinical experience to complement data to create greater understanding of a likely scenario
• Excellent Communication Skills, ability to communicate complex information in spoken and written English in a simple clear format to both clinical and non-clinical audiences. Writes clearly and informatively

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy  

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.    

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.      

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.